Provider Demographics
NPI:1316110034
Name:IRWIN, LYDIA SUE (SW)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:SUE
Last Name:IRWIN
Suffix:
Gender:F
Credentials:SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 IRWIN DANIELS ROAD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:KY
Mailing Address - Zip Code:42602
Mailing Address - Country:US
Mailing Address - Phone:606-688-1975
Mailing Address - Fax:
Practice Address - Street 1:218 IRWIN DANIELS ROAD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:KY
Practice Address - Zip Code:42602
Practice Address - Country:US
Practice Address - Phone:606-688-1975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-03
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3274104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker